CAJ | 학술논문

目的探讨距骨体骨折的手术治疗效果及注意事项.方法 2002年4月至2008年7月,手术治疗距骨体骨折患者44例,男41例,女3例;年龄15～61岁,平均31.7岁;左侧26例,右侧18例.根据Sneppen分型,Ⅱ型24例,V型20例.开放性骨折11例,根据Gustilo和Anderson分型,Ⅰ型3例,Ⅱ型7例,ⅢA型1例.致伤原因:高处坠落伤18例,交通事故伤13例,重物砸伤8例,扭伤4例,刀砍伤1例.开放性骨折平均在伤后5.3 h手术,闭合性骨折平均在伤后8.9 d手术.闭合性骨折采用前内侧切口15例,前外侧切口3例,内外侧联合切口15例.44例患者中,3例单纯应用克氏针固定;5例采用螺钉辅以克氏针短期固定;2例采用可吸收螺钉固定;34例采用空心拉力螺钉固定,其中4例辅以全螺纹松质骨螺钉固定.结果 35例患者获得随访,随访时间21～89个月,平均44.5个月.4例出现切口皮缘坏死,1例出现伤口感染,均经治疗后愈合.骨折均愈合,愈合时间为17～41周,平均22周.美国足与踝关节协会(AOFAS)功能评分为43～100分,平均77.3分;优11例,良13例,可10例,差1例,优良率为68.6%.5例患者发生距骨缺血性坏死;19例患者发生创伤性关节炎,其中4例行关节融合术.结论治疗距骨体骨折时应根据骨折和软组织损伤的具体情况选择手术时机和入路,保护血供、解剖复位及早期功能锻炼是取得良好疗效的关键.
목적 탐토거골체골절적수술치료효과급주의사항.방법 2002년4월지2008년7월,수술치료거골체골절환자44례,남41례,녀3례;년령15～61세,평균31.7세;좌측26례,우측18례.근거Sneppen분형,Ⅱ형24례,V형20례.개방성골절11례,근거Gustilo화Anderson분형,Ⅰ형3례,Ⅱ형7례,ⅢA형1례.치상원인:고처추락상18례,교통사고상13례,중물잡상8례,뉴상4례,도감상1례.개방성골절평균재상후5.3 h수술,폐합성골절평균재상후8.9 d수술.폐합성골절채용전내측절구15례,전외측절구3례,내외측연합절구15례.44례환자중,3례단순응용극씨침고정;5례채용라정보이극씨침단기고정;2례채용가흡수라정고정;34례채용공심랍력라정고정,기중4례보이전라문송질골라정고정.결과 35례환자획득수방,수방시간21～89개월,평균44.5개월.4례출현절구피연배사,1례출현상구감염,균경치료후유합.골절균유합,유합시간위17～41주,평균22주.미국족여과관절협회(AOFAS)공능평분위43～100분,평균77.3분;우11례,량13례,가10례,차1례,우량솔위68.6%.5례환자발생거골결혈성배사;19례환자발생창상성관절염,기중4례행관절융합술.결론 치료거골체골절시응근거골절화연조직손상적구체정황선택수술시궤화입로,보호혈공、해부복위급조기공능단련시취득량호료효적관건.
Objective To investigate the results and related key points in operative treatment of talar body fractures. Methods From April 2002 to July 2008, 44 patients with talar body fractures underwent the operation. There were 3 females and 41 males. The mean age of the patients was 31.7 years. The fractures occurred on the left side in 26 patients and on the right side in 18 patients. According to Sneppen classification, 24 type Ⅱ, 20 type V. Eleave cases were open fractures, according to the Gustilo-Anderson classification, there were 3 cases in type Ⅰ , 7 in type Ⅱ, 1 type in Ⅲ A. The mean interval between injury and surgical treatment for open fractures and close fractures was 5.3 hours and 8.9 days. The mechanism of injury was a fall from the height in 18 patients, a traffic accident in 13 patients, a crush injury in 8 patients, a sprain injury in 4 patients and a cut injury in 1 patient. Anteromedial approach was used for 15 close fractures, anterolateral approach for 3 and combined anteromedial-anterolateral approach for 15. K-wires fixation were utilized for 3 fractures, screws and temporary K-wires fixation for 5 cases, bioabsorbable screws for 2fractures, cannulated screws for 30 fractures and cannulated screws and threaded cancellous screws for 4cases. Results Thirty-five patients were followed up 21 to 89 months (average, 44.5 months). Necrosis of incision was found in 4 cases, wound infection occurred in 1 case. All fractures had achieved bone union;the average healing time was 22 weeks. Functional results were assessed according to AOFAS score, the average score was 77.3, There were 11 patients in excellent results, 13 in good, 10 in fair and 1 in poor. The overall excellent and good rate was 68.6%. Avascular necrosis occurred in 5 cases. Traumatic arthritis occurred in 19 cases. Arthrodesis was needed in 5 cases. Conclusion The timing and approach of surgery is determined by the condition of the talar fractures and soft tissue. Anatomical reduction, preservation of the blood supply and early active pain-free mobilization are key points in the treatment of the talar body fractures.